No todo es culpa de la anestesia: neumoencéfalo vs ictus tras anestesia neuroaxial

Aunque las complicaciones neurologicas asociadas a las tecnicas neuroaxiales de anestesia son muy poco frecuentes la potencial gravedad de las mismas constituye un motivo de preocupacion tanto para los pacientes como para los profesionales. La aparicion de una alteracion neurologica en el periodo postoperatorio tiende a interpretarse como yatrogenica, lo que en algunos casos puede dificultar el correcto diagnostico. Presentamos el caso de una paciente sometida a tecnica combinada epidural-subaracnoidea, que presento clinica de deficit neurologico focal a las 24 horas de la intervencion. En la TAC craneal destacaba como hallazgo radiologico minimos focos de neumoencefalo, lo cual hizo que se atribuyera erroneamente la sintomatologia a una complicacion de la anestesia. En una TAC de control posterior se observo una region isquemica compatible con la clinica neurologica. Ante un evento neurologico adverso en el postoperatorio, es imprescindible realizar una evaluacion cuidadosa del mismo, valorando todas las posibles causas antes de etiquetarlo como yatrogenico. Title: Not everything is because of anaesthesia: pneumoencephalon vs ictus after neuraxial anaesthesia Abstract: Although neurological complications due to anaesthesic neuraxial techniques are rare, its potential seriousness is a concern for patients and for proffesionals as well.The appearance of an neurological alteration in postoperative period tends to be considered as iatrogenic, which in some cases may make difficult the right diagnosis.Here we have a case with a patient treated with a epidural subarachnoid combined techique, which happened to present neurological focal shortage 24 hours after assistance. CT highlighted as radiologic finding minimal pneumoencephalon focus, which made symptomatology wrongly attributed to an anaesthesia complication. In later control CT a compatible ischaemic region with neurological clinical advise could be seen.In the presence of side neurological effects in post operative period, is essential to perform a careful evaluation, evaluating all possible reasons before considering as iatrogenic.